Concussions and the NFL

Over the past three years, 17 high school football players have died after sustaining head injuries while playing. A similar situation in the NFL would have caused a national uproar, so how has this been allowed to happen to our youth?

Take a look at trailer for this riveting episode of HBO’s series Real Sports with Bryant Gumbel, which is airing several times on HBO through mid-December 2016, as well as On Demand. The episode as a whole explores why there are such inconsistencies in protecting professional athletes versus the youngest players.

The much-anticipated movie “Concussion” is scheduled for release this year on Christmas Day, and already there is Oscar Award talk for Will Smith, who plays the role of Dr. Bennet Omalu. It was Dr. Omalu who discovered the tragic progressive degenerative effects of years of multiple concussions in NFL players, which he named CTE (chronic traumatic encephalopathy).

Bennet Omalu, M.D., (L) and actor Will Smith attend the screening of the major motion film, “Concussion,” on November 23, 2015. (VALERIE MACON/AFP/Getty Images)

The film highlights the NFL’s initial response of anger and denial. Indeed, since Dr. Omalu’s discovery in 2002, the NFL has experienced lawsuits, exposés, and finger-pointing in general. Now, 13 years later, bystanders have watched the NFL’s reaction to this scientific research unfold in a manner not unlike many stages of grief – first denial, then anger, on to bargaining and, finally, acceptance. (Although, the League is still working on fully coming to terms with this last step.)

For their part, the NFL hasn’t had much reaction to the movie, preferring to keep the controversy at arm’s length. While Dr. Omalu has vocalized his opposition to children playing football until they are legally and emotionally old enough to understand the danger of putting their brains at risk, the NFL can’t afford to lose any of their reported $7+ billion in annual revenue.

Yet, while the debate rages on, two points are patently clear from years of scientific research: that children repeatedly hitting their heads during developmental years is potentially very harmful, and that college and professional football players can face significant health consequences from playing the sport.

But just how serious are families going to be about keeping their children from playing football? Indeed, this is just the beginning of the conversation about brain injuries.

As a community-based concussion clinic that has treated more than 30,000 traumatic brain injury patients over the past three years, HeadFirst Concussion Care has seen multiple reasons for why people sustain concussions. And while football is a violent sport, soccer, lacrosse and hockey also put our youth at risk for head trauma.

And again, this is just half of the dialogue. HeadFirst’s data shows that traumatic brain injuries sustained while playing organized sports with a concussion protocol in place (high school or college sports) account for a relatively small percentage of our patients. In fact, in as many as 80 percent of our patients, concussions are sustained by other mechanisms of injury. These include non-organized sports-related injuries (bike riding, skateboarding, trampolining, skiing, pick-up or other informal recreational games), slips and falls, motor vehicle accidents, and assaults.

The key message is that the people must understand that traumatic brain injuries can happen to anyone, anywhere, at any time. Not just kids. Not just athletes. And certainly, not just NFL players. And since anyone is at risk, everyone must understand the proper protocols for healing an injured brain.

On a final note to end the year, my holiday wish is that families, schools, and employers begin to talk about head injuries and follow traumatic brain injury protocols to keep all children and adults safe.

I’m a season ticket holder of Navy football and also a huge fan of Army and Air Force football. These kids stand for a bit more than just playing football…and if I’m going to spend money I’d rather support the Brigade of Midshipmen and Air Force and West Point Cadets. But that’s a blog post for another day.

The bottom line is that I’m a huge football fan. The lessons that come from football often can’t be taught in a classroom.

NFL wide receiver Wes Welker has incredible numbers for the New England Patriots and now for the Denver Broncos. But for Wes, the most troubling concern is his three concussions in the last nine months. And watching the game last Sunday he looked as though he got clobbered and never saw the hit coming late in the fourth quarter.

Sometimes, parents will ask me “How many concussions are too many and when should I start looking for another sport for my little one?”

Presently there is no definitive number of concussions published in the literature. But three tends to be my number as a provider. If an athlete has had three significant neurological events — a concussion or mild traumatic brain injury —and there was a change in their mental status, that’s worthy of a discussion with the parents.

Clinicians will look at a number of factors such as mechanism of injury, intensity of symptoms, and length of time until complete recovery. I’ve had a patient who had a single mTBI and I had to talk to the parents about potentially choosing another sport after their child took 14 months to recover. Conversely, I’ve worked with parents after their child has had her sixth concussion but recovered in a week.

Wes Welker appears to have just had his fourth concussion in 10 months and I’m sure he’s having talks with his coaches and family about his health and recovery.

Here at HeadFirst Concussion Care, we have thousands of visits to treat head traumas. And, in many of those visits, I am often asked if sports are worth it.

The primary danger with a head injury is returning too soon before the injury has had a chance to heal itself. Play it safe. When in doubt, sit it out. In almost every case, the brain will heal and the child can return to his or her love of sports.

On Sunday, Washington Redskins quarterback, Robert Griffin, III was knocked out. According to his coach, Mike Shanahan, he received a mild concussion. When asked about RGIII, Shanahan said the following – “He wasn’t sure what quarter it was in the third quarter. So at that time, when he wasn’t really sure what the score was, what the quarter was, we knew he had a mild concussion — at least according to the doctors,”

This leads us to the question – is it possible to get a “mild” concussion?

And the resounding answer is NO!

According to the CDC a concussion is a brain injury, and ALL are serious.

When talking about concussions, the word mild can be used to describe the symptoms. Symptoms can be mild to severe. You will also hear the word mild to describe the type of brain injury. A concussion is a mild traumatic brain injury, but do not confuse this with having a “mild” concussion. Again all concussions are serious and need to be treated that way.

We came across this incredible editorial written by Kurt Warner for the June 12, 2012 issue of USA Today. It blasts through stereotypes on many levels, from the notion that football players are “dumb jocks” to the perception that the game is all-important. Warner has delivered a thought-provoking essay about the issue of concussions in youth sports in a style that is nothing less than poignantly eloquent.

Kurt Warner and son, Kade. (Courtesy Brenda Warner)

Like many Americans, I am passionate about the game of football. I love the strategy, the competitiveness, the discipline and the effort required to succeed as a team. I respect the values the game teaches. But I’m acutely aware of the one aspect of the game I don’t love — the violence. Kurt Warner and son Kade.

Recently, with the shock of Junior Seau’s suicide fresh on my mind, I shared my concerns about my own boys playing football because of the risks of concussions. Some people labeled me a traitor, and others said I was sabotaging the NFL. How dare I criticize a game that gave me so much?

As a parent, I expressed my unease precisely for that reason. I love the game deeply, and love my kids even more deeply. That’s why we need to do everything in our power to make the game as safe as possible.

I’ve spent 22 years helping raise a child who has a traumatic brain injury. I understand the perils that these conditions can cause firsthand. Our son Zack, who suffered an accident as a baby, is an awesome blessing, but it moves me to watch the daily struggles he endures. For that reason alone, I hope people can understand my fear of placing any of my kids in an environment where brain trauma is a possible byproduct of the competition. My sentiments about my boys playing football are reflective of that.

Sports and life lessons

To be clear, few things bring me greater joy than watching my boys play football. They are learning some incredible life lessons and absorbing the values the sport instills. But I know the violence intrinsic to the sport. That knowledge carries as much, if not greater, importance.

I spent 12 seasons as an NFL quarterback. I suffered concussions. I was trained to be tough and play through injury. No doctor could say for sure whether I suffered lingering effects. Those concussions led me to walk away from the game I love. As my boys continue to play, I worry about them every time they get hit, just as my wife worried about me every time I got hit.

More than worrying

It isn’t enough, though, for parents to worry. We all know that injuries are part of football. We fall short as guardians if we don’t try to reduce traumatic injuries such as concussions, especially with the information we now have. If we’re going to be supportive of our kids’ passion to play, then we need to educate them about the risks as well.

NFL commissioner Roger Goodell is doing all he can to improve safety. There are signs of improvement through better equipment or changing what is acceptable in terms of hard hits. NFL protocol mandates that any player showing concussion-like symptoms cannot re-enter a game.

Last year, my son Kade was required by his Pop Warner team to undergo a baseline test to analyze brain function in a normal state so that if he suffers a concussion, officials have a comparison. These and other safeguards are helping players, coaches, parents and doctors to treat concussions and avoid putting someone back into a situation where more damage can be done.

For me, the benefits almost always outweighed the risks. The game helped shape me into who I am today. When I think about my own boys, especially with Father’s Day coming up, it’s sometimes hard to feel that the thrills outweigh the dangers.

Consequently, I support all improvements in player safety in hopes that the game has a long and healthy run as the greatest team sport in the world. We owe it to the generations of players to come, and as parents, we owe it to our kids to educate and protect them.

Kurt Warner is a retired quarterback, a two-time NFL MVP and an NFL Network analyst.

Whose responsibility is to make sure an athlete remains concussion free? The player? The coach? Parents? Well, at least 2,500 people believe it should be the helmet manufacturers.

Right now 2,500 plaintiffs are seeking damages against Riddell because they believe the sports equipment company had a duty to protect NFL players against the long-term risk of concussions, yet defaulted on that obligation.

Further, the plaintiffs believe that Riddell falsely marketed their helmets as having the ability to reduce the risk of concussions by a substantial percentage. Plaintiffs refer to Riddell’s Revolution helmet in their Master Complaint, pointing out that Riddell marketed the helmet as reducing concussions by 31%.

In response to this accusation, all Riddell Football Helmets now include concussion awareness hang-tags with information from USA Football and the CDC.

Whose responsibility is it to educate the sports community about the dangers of concussion? In our estimation, everyone.

Lem Barney played with the Detroit Lions from 1967-77. (Courtesy Detroit Lions)

Several class action lawsuits recently brought against the NFL by retired players have catapulted the subject of concussions into the headlines. Just this week, Detroit Lions great Lem Barney told the Detroit Free Press that his experiences with the life-altering symptoms of concussions have made him wish he’d never played the game.

“If I had another choice I’d never played the game, at all, in my life,” Barney says. “Never. Never. It would be golf or tennis.” This, from a man who was 1967’s Defensive Rookie of the Year and played in seven pro bowls during his illustrious 10-year Lions career.

Fortunately, the Football Hall of Famer has not suffered as many debilitating symptoms related to brain trauma as numerous former colleagues have experienced. He’s been diagnosed with nerve damage that causes tingling in his fingers, hands and forearms that limits his sleep without medication. But, with several spots on his brain that show the effects of multiple hits to the head, he’s very much committed to crusading against players coming back to their sport too soon after having concussions.

Barney’s insistence on focusing attention on the subject has resulted in his testifying to Congress about the dangers of concussions, speaking out about protecting today’s NFL players and joining 105 other former NFL players in a lawsuit against the organization for their negligence in treating and diagnosing head injuries.

What were once called, in Barney’s words, “ringers, stingers and bell-ringers,” could now change the NFL’s entire approach to concussion awareness. League commissioner Roger Goodell has already gone on record saying the NFL is pioneering research “to make sure we understand all there is about brain injuries and brain disease.” For Lem Barney, that would be just fine.

What do you think about lawsuit against the NFL? Are players like Lem Barney justified in their crusade for legal accountability? Tell us in the comments.